Dealing with a Senior’s State of Denial Is a Caregiver’s Challenge

Debby Weiss wrote in The Huffington Post that she had a hard time forgiving herself for becoming angry and yelling at her dying husband. Beyond the many sources of anger that a caregiver may feel, this caregiver had to face the fact that her stoic husband was in denial about his illness. Despite being wheelchair-bound as his cancer progressed and having fallen several times, he would not admit that they might need outside help. He denied the severity of his illness even after his wife-caregiver showed him photos of his deteriorating back. One of his last acts before dying was to plead with her to not call 911.

Denial is not an uncommon response in life-threatening situations, as Elisabeth Kübler Ross has said. It is often the first response when an extremely uncommon thing happens, such as in the above case when a man under fifty learns he has cancer. Some people’s response during the September 11th terrorist attacks on the World Trade Center was denial—even when they saw a plane slamming into a building outside their windows.

It may be an emotional shield that allows the person to absorb the news…

We almost want to scream at such people to get them to wake up and deal with what is happening. Yet denial is a way of dealing with it. It may be an emotional shield that allows the person to absorb the news, just as the body goes into shock upon intense injury to numb the pain and distance the person from the traumatic event. Humans can only bear so much, and they have physical and psychological back-up systems that insulate them from the worst. Denial is one of the insulating back-up systems.

In the case of the caregiving wife, she later realized that her husband’s denial of the severity of his illness was so that he could live out his remaining time in a semblance of a normal life with her. He did not allow her to visit the hospital or speak to his doctors. Perhaps he was trying to treasure the little amount of time they had left together—of which he was aware and she was not.

In her book, The Unthinkable, Amada Ripley goes into detail about the story of 9/ll survivor Elia Zedeño, who spent much of the time during her escape from the Trade Center in denial. Even after the plane hit her building, she wanted to stay in her office.

Many people, the author writes, become lethargic and delay action when facing overwhelming events. Though dazed, Zedeño and most of the people going down the stairs were calm and unhurried. Even when the second plane hit, Zedeño refused to deal with the reality of terrorism, concentrating instead on getting down the stairs a step at a time. For a long time she had assumed that the plane hitting the building was an accident. Even when it became clear that the attack was deliberate, she put these thoughts out of her mind. It was more than she could deal with.

When she reached the ground floor, her mind took time to realize that she was seeing dead bodies not just debris. She experienced moments of blindness. When a woman took her arm to steer her to safety in a dazed condition, she could not remember the woman’s features or those of the firemen and policemen she knew were present. Part of her mind shut down, making her blind to the overwhelming amount of distressing stimuli.

Denial can do us harm when we fail to take appropriate action because of it.

Denial can do us harm when we fail to take appropriate action because of it. Ripley notes that denial worked against persons who stayed in New Orleans during Hurricane Katrina even after mandatory evacuations were ordered.

Yet it can also work for us by helping us not face what we are not yet prepared to face, such as our mortality and the limitations of time on earth wrought by age and illness.

Kübler-Ross says of denial: “I regard it as healthy way of dealing with the uncomfortable and painful situation with which some of these patients have to live for a long time. Denial functions as a buffer against unexpected shocking news, allows the patient to collect himself and, with time, mobilize other, less radical defenses.”

Denial has its place, maddening at it may be to those who see clearly that the person is not facing facts. In most cases, the patient actually knows deep inside what the real story is, whether or not a doctor has advised of the true physical state of affairs. Thus, Kubler-Ross counsels patience, and not to consider it “regression” when a person has progressed toward more acceptance but reverts to denial again. Caregivers should gently allow for the survival value—especially the psychological survival value of denial—and let the person progress naturally toward greater acceptance of reality.

Sources

Kübler-Ross, E. (1969). On Death and Dying. New York: Scribner. P. 32.

Weiss, D. (11/12/2015). Forgiving the Caregiver: I Yelled at my Dying Husband. The Huffington Post. The Blog. Reprinted by permission from http://www.xojane.com. Available online at http://www.huffingtonpost.com/debbie-weiss/yelled-at-my-dying-husband_b_8483250.html. Accessed November 13, 2015.

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